Why are people so lusting over super competitive residencies?

[MetricSystem]

Hey SDNers,
So more recently, I've been seeing "go to any MD over DO schools, unless family issues" and threads about unlikeliness of DOs going into competitive residencies, which made me come up with the question in the title.

When I was a Pre-med student, I just wanted to get accepted to a school.
Now that I have been accepted to a school, I am thinking about residencies (I know it's early since I didn't even start school but...).
And at this moment, I want to be do EM or general surgery, which I believe isn't super competitive and pretty DO friendly. Also not super competitive.
However, I just want to know why certain people want to go into those supercompetitive residencies.
I mean, I don't even know what dermatologist, neurosurgery, urology, radio-onc, or ENT really do. What makes people want to choose certain specialties? Especially those super competitive ones.

Is it based on your experiences (which is my reason)?
Is is b/c of money?
Uniqueness?
Location?

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[Mad Jack]

Lifestyle, money, lifestyle, lifestyle, lifestyle. Derm is derm, it's solid pay without killing yourself to earn it. Neurosurg is pay, prestige, and playing god for those that get off on that. Rad-onc is a decent lifestyle field. Urology and ENT give you most of the bonuses of general surgery without many of the downsides, plus extra cash to boot.

 

[67552931811]

Hey SDNers,
So more recently, I've been seeing "go to any MD over DO schools, unless family issues" and threads about unlikeliness of DOs going into competitive residencies, which made me come up with the question in the title.

When I was a Pre-med student, I just wanted to get accepted to a school.
Now that I have been accepted to a school, I am thinking about residencies (I know it's early since I didn't even start school but...).
And at this moment, I want to be do EM or general surgery, which I believe isn't super competitive and pretty DO friendly. Also not super competitive.
However, I just want to know why certain people want to go into those supercompetitive residencies.
I mean, I don't even know what dermatologist, neurosurgery, urology, radio-onc, or ENT really do. What makes people want to choose certain specialties? Especially those super competitive ones.

Is it based on your experiences (which is my reason)?
Is is b/c of money?
Uniqueness?
Location?

$, lifestyle, and more $.

If FM salary doubled tomorrow it would *instantly* become highly competitive.

Who cares what people lust after. You do you. I have 0 interest in any of the competitive specialities because I grew up around medicine and would either want to off myself (surgery) or would be bored out of my skull (derm). I've seen enough people chase after $ to know it is just not worth it. To me it's parasitic but hey to each their own.

 

[Mad Jack]

$, lifestyle, and more $.

If FM salary doubled tomorrow it would *instantly* become highly competitive.

Who cares what people lust after. You do you. I have 0 interest in any of the competitive specialities because I grew up around medicine and would either want to off myself (surgery) or would be bored out of my skull (derm). I've seen enough people chase after $ to know it is just not worth it. To me it's parasitic but hey to each their own.

Back in the day, derm didn't make near what other professions do, and was looked at in a way pathology might be looked at now- an intellectually interesting field that has a decent lifestyle, doesn't pay particularly well, and doesn't carry any real prestige. Then along game cosmetic procedures and treatments that doubled the incomes of many dermatologists, and the next thing you know derm became the most competitive specialty out there.

 

[MetricSystem]

I just want a small home with a pool in the back and ~0.1 acre of yard.
Go on vacations maybe 3-4 times a year and pay for small things without having to worry about going over bank account balance. Is that too much to ask?

 

[Awesome Sauceome]

Back in the day, derm didn't make near what other professions do, and was looked at in a way pathology might be looked at now- an intellectually interesting field that has a decent lifestyle, doesn't pay particularly well, and doesn't carry any real prestige. Then along game cosmetic procedures and treatments that doubled the incomes of many dermatologists, and the next thing you know derm became the most competitive specialty out there.

good God and mohs..... With our current procedure based payment system, its insane.

 

[cliquesh]

I just want a small home with a pool in the back and ~0.1 acre of yard.
Go on vacations maybe 3-4 times a year and pay for small things without having to worry about going over bank account balance. Is that too much to ask?

You're just going to have to experience medical school. During your clinical rotations you will discover that you like some specialities and hate others. What if the only specialities you like happen to be competitive? You're going to want to put yourself in the most advantageous position, which includes attending a MD school over a DO school. I went to school thinking I was going to do family medicine. By the end of my 3rd year I was only considering radiology, anesthesia, and pathology. Your opinions and preferences will change a lot over the next 4 years. I think it's better to play it safe than be sorry when the match comes around.

 

[j4pac]

A good majority of physicians are type-A people. They want to achieve as much as they can. People will say it's money and prestige...but it is much more to do with medical professionals being perfectionists and ultra-competitive.

 

[emflem]

Isn't it in part that people would rather have plenty of options post-residency than have to take whatever job you can find?

 

[MetricSystem]

Of course I understand people wanting more and having more options as an MD (if you put effort in it).

Forgot to ask this question.
Do physicians who went through those competitive residencies (post) make significantly much more money than other doctors who went through less competitive residencies within the same specialty?

For example,
2 EM physicians in NYC, one noncompetitive residency and other competitive.
And lets just say avg salary for EM is ~150k nation wide.
Now, does the Comp EM make 200k while the Non-C EM make 100k?
Or is it more like Comp EM 170K vs Non-C EM 130K?

Just curious.

 

[cliquesh]

Of course I understand people wanting more and having more options as an MD (if you put effort in it).

Forgot to ask this question.
Do physicians who went through those competitive residencies (post) make significantly much more money than other doctors who went through less competitive residencies within the same specialty?

For example,
2 EM physicians in NYC, one noncompetitive residency and other competitive.
And lets just say avg salary for EM is ~150k nation wide.
Now, does the Comp EM make 200k while the Non-C EM make 100k?
Or is it more like Comp EM 170K vs Non-C EM 130K?

Just curious.

Nah, I don't think it matters. The only study I've seen about this subject showed that graduates from lower tier radiology residencies make more money than graduates from higher tier programs. Mostly because higher tier graduates often stay in academics, which pays less. I'm sure if you search pub med you'll be able to find similar studies for other specialties.

Keep in mind that if you go to a competitive place for residency, like john hopkins for internal medicine, it makes getting a fellowship a lot easier. If you want to do GI, for example, you're going to have a hard time matching a GI fellowship from a no named community internal medicine program. If you don't want to do a fellowship then it probably doesn't matter too much where you go, at least in terms of post graduate income.

 

[Drrrrrr. Celty]

A combination of people already wanting it ( And thus ppl's opinion of it being positive) and then people inherently wanting it. You know, the same drives that lead ppl into medicine in general....

But yah, I think most people want the quiet tranquil life that certain specialties provide. It's probably why sooner or later psychiatry will probably see similar derm-esk status.

 

[MetricSystem]

Only if physicians made more $ than pro athletes... or 350K across the board (no pun intended).

 

[NontradCA]

The prestige factor has been ignored. There are plenty of specialties that afford little lifestyle and are competitive. Basically any surgery, cards, cc, come to mind. You are talking about A type culture. I think Neurosurgery will always be competitive and Psych uncompetitive.

Its more than lifestyle and money. Look at Plastics v. Derm for instance. I also think this is factored into the culture of DO students and specialty choice. I'm surprised at how many folks want to do family medicine from day 1.

 

[cabinbuilder]

Of course I understand people wanting more and having more options as an MD (if you put effort in it).

Forgot to ask this question.
Do physicians who went through those competitive residencies (post) make significantly much more money than other doctors who went through less competitive residencies within the same specialty?

For example,
2 EM physicians in NYC, one noncompetitive residency and other competitive.
And lets just say avg salary for EM is ~150k nation wide.
Now, does the Comp EM make 200k while the Non-C EM make 100k?
Or is it more like Comp EM 170K vs Non-C EM 130K?

Just curious.

Nope, as long as you are board certified you get paid the same. It's all a mental thing. I don't even know where the docs I work with went to school let alone residency.

 

[cabinbuilder]

I just want a small home with a pool in the back and ~0.1 acre of yard.
Go on vacations maybe 3-4 times a year and pay for small things without having to worry about going over bank account balance. Is that too much to ask?

I have that doing FP urgent care and take more vacations than that. I think I"m hitting a total of 12 weeks this year. My question is what income do you think is "good".

 

[feeling-dizzy]

Because of $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

 

[feeling-dizzy]

the Heart wants what It wants, want want want $$$

 

[DloopF2]

By nature med students are competitive people.

 

[Bea5T]

 

[cabinbuilder]

the Heart wants what It wants, want want want $$$

And what income is a "great" number to you?

 

[Mad Jack]

Of course I understand people wanting more and having more options as an MD (if you put effort in it).

Forgot to ask this question.
Do physicians who went through those competitive residencies (post) make significantly much more money than other doctors who went through less competitive residencies within the same specialty?

For example,
2 EM physicians in NYC, one noncompetitive residency and other competitive.
And lets just say avg salary for EM is ~150k nation wide.
Now, does the Comp EM make 200k while the Non-C EM make 100k?
Or is it more like Comp EM 170K vs Non-C EM 130K?

Just curious.

There is generally no difference in salary. Some groups might be more likely to take you on if you went to certain prestigious places, but most of the time it won't matter, particularly in EM. The big difference is in academic medicine- prestigious residencies put you at a substantial advantage when competing for academic posts. But if you're just looking for salary, you won't make less money as a community-trained EM doc versus a high-tier university trained EM doc in 95% of scenarios.

 

[MetricSystem]

I have that doing FP urgent care and take more vacations than that. I think I"m hitting a total of 12 weeks this year. My question is what income do you think is "good".

"Good" for me is... enough to keep me fed.

 

[cabinbuilder]

"Good" for me is... enough to keep me fed.

Ah, then you should be fine being a bus driver then. Less hours too.

 

[Seth Joo]

Hey SDNers,
So more recently, I've been seeing "go to any MD over DO schools, unless family issues" and threads about unlikeliness of DOs going into competitive residencies, which made me come up with the question in the title.

When I was a Pre-med student, I just wanted to get accepted to a school.
Now that I have been accepted to a school, I am thinking about residencies (I know it's early since I didn't even start school but...).
And at this moment, I want to be do EM or general surgery, which I believe isn't super competitive and pretty DO friendly. Also not super competitive.
However, I just want to know why certain people want to go into those supercompetitive residencies.
I mean, I don't even know what dermatologist, neurosurgery, urology, radio-onc, or ENT really do. What makes people want to choose certain specialties? Especially those super competitive ones.

Is it based on your experiences (which is my reason)?
Is is b/c of money?
Uniqueness?
Location?

$$$$, that is why.

 

[Lawgiver]

because medical prestige allows you to say stuff like "access to healthcare is worse than slavery", and have people still take you seriously as a human being. 🙂

 

[GypsyHummus]

$$$

You Take out 250K+ in loans, 8 years of undergrad and med school and just aced your boards. Are you still considering a career in primary care as a first choice? For 95% of the population, that answer is no, for the other 4% you scrambled in somewhere, and for the 1% you are hippies.

 

[GypsyHummus]

By nature med students are competitive people.

Im not, I detest the game, especially the one that premeds had to play. I have mellowed somewhat during the last 4 years of undergrad, but honestly, its a rat race at this point

 

[GypsyHummus]

I have that doing FP urgent care and take more vacations than that. I think I"m hitting a total of 12 weeks this year. My question is what income do you think is "good".

I think a good take home would be 120K. Great would be 250K. Amazing would be 350K+

Is it possible for a family doc to hit 220K take home? so around 250K gross?

 

[feeling-dizzy]

And what income is a "great" number to you?

There is really no good number of income that satisfy any of us. We always want more and more money. It is like bilionares like Trump still wants to make more money. In a way, ppl will want to make the most of their career, regardless of how high their starting point. A family doctor makes 200k is still never enough since the neurosurgeon makes 800k. Thus ppl will always compete for top residency to get more $$$; there is really no shame in that really.

 

[67552931811]

I think a good take home would be 120K. Great would be 250K. Amazing would be 350K+

Is it possible for a family doc to hit 220K take home? so around 250K gross?

? If your gross is 250 your take home would be nowhere near 220.

 

[MetricSystem]

? If your gross is 250 your take home would be nowhere near 220.

yea... you will be lucky to take home ~150-160k after everything if your gross is 250k...

 

[cabinbuilder]

I think a good take home would be 120K. Great would be 250K. Amazing would be 350K+

Is it possible for a family doc to hit 220K take home? so around 250K gross?

I hit 300K this year doing locums. Been seeing lots of jobs come across my email lately that are 220K + RVU. I just turned down a job that was 220K because it was too low. 120K for FP is what PA's make so don't sell yourself short. ANY starting FP job should be 180K and you should never go under that. Just remember that FP is THE hot commodity right now and ALL numbers are negotiable and you never know how high they will go if you don't ask. All contracts start at the lowest possible they think they can get away with. Remember that.

 

[cabinbuilder]

yea... you will be lucky to take home ~150-160k after everything if your gross is 250k...

Not if you have a great tax accountant, make yourself an LLC. That's 100K in taxes!!! No way. Most I have ever paid in taxes was 40K when I made 250K so be sure you have a good accountant who covers your butt when they move the numbers around and take the heat and have insurance if the IRS audits your return.

 

[Lawgiver]

thats 16%. Doesnt look like you are paying your fair share. 😛

 

[cabinbuilder]

There is really no good number of income that satisfy any of us. We always want more and more money. It is like bilionares like Trump still wants to make more money. In a way, ppl will want to make the most of their career, regardless of how high their starting point. A family doctor makes 200k is still never enough since the neurosurgeon makes 800k. Thus ppl will always compete for top residency to get more $$$; there is really no shame in that really.

1. A Neurosurgeon earns an average salary of $346,791 per year. Skills that are associated with high pay for this job are Spine Surgery and Brain Surgery. Pay for this job rises steadily for more experienced workers, but goes down significantly for employees with more than 20 years' experience.

 

[cabinbuilder]

thats 16%. Doesnt look like you are paying your fair share. 😛

Hardly. You won't feel the same when you are writing a check for more than what most make in a year. I love my accountant.

 

[hallowmann]

There is really no good number of income that satisfy any of us. We always want more and more money. It is like bilionares like Trump still wants to make more money. In a way, ppl will want to make the most of their career, regardless of how high their starting point. A family doctor makes 200k is still never enough since the neurosurgeon makes 800k. Thus ppl will always compete for top residency to get more $$$; there is really no shame in that really.

While I see your point, it's not entirely accurate, especially when you deal with diminishing returns or losing your opportunity to actually use the money. I know plenty of docs that could make 50% more by working 6 days/week as opposed to 5. They won't do it. They'd rather spend time with their kids and spouses and actually have fun spending some of the money they earn.

In answer to OP's question, it's all about keeping your options open. There are some fields and some programs that are significantly harder to get into as a DO. Sometimes it's about money and prestige, but a lot of the time its about personal interest/preference and lifestyle. Also, I'll reiterate what people said, that it is not only possible, but likely that your interests will change while in med school, especially since you don't know very much about different medical fields, as you've mentioned.

 

[DocWinter]

I agree with you OP, I don't have interest in the high end specialties. If FP is a 1 and Neurosurg a 10, the specialties that interest me probably top out at 5.

I'd say the combination of big money, prestige/power associated with the position and the inability to NOT be a type A, go-big-or-go-home personality make it worthwhile for many people. When you're used to being in school and learning your whole life, it's a lot easier to stomach a 7 year residency and keep going through what's natural.

 

[Dave Chester]

Wow, people, what happens to genuine passion?

 

[67552931811]

Wow, people, what happens to genuine passion?

When you're facing crippling debt until your 45 some priorities start to more heavily factor in (like, how can I not be in debt until I'm 45....).

 

[Bea5T]

When you're facing crippling debt until your 45 some priorities start to more heavily factor in (like, how can I not be in debt until I'm 45....).

To be fair, there are some incentives in going FM due to loan forgiveness/repayment programs. Yea, you'll be in a rural area, but it's only for 3 years

 

[Dave Chester]

When you're facing crippling debt until your 45 some priorities start to more heavily factor in (like, how can I not be in debt until I'm 45....).

There are plenty of programs out there that gladly pay off your debts if you work for them. There are also IBR and PAYE. In short, you will pay it off in 10 years; 20 years at most if you choose IBR/PAYE. https://studentloans.gov/myDirectLoan/mobile/repayment/repaymentEstimator.action
There is some poster who made this awesome Excel worksheet that calculates how much you could pay off in a x year scenario: http://forums.studentdoctor.net/thr...tions-of-dental-school-excel-document.868931/

 

[cabinbuilder]

When you're facing crippling debt until your 45 some priorities start to more heavily factor in (like, how can I not be in debt until I'm 45....).

I totally get this. I graduated residency at 40, played with my kids for 4.5 years and at 45 started the year with the mantra of "debt free in 3". So I am one year in, my goal was to hit 300K this year (which I did), paid 250K in debt, have 400K to go. Now that includes my student loans, my condo, my house, my cars, and all other personal debt. I will be debt free in 2 more years if it kills me because I don't want to be doing a 70 hour week at age 50. I want to work part time and travel. It can be done in FP, you just have to know how to work it and make the money you want.

 

[cabinbuilder]

To be fair, there are some incentives in going FM due to loan forgiveness/repayment programs. Yea, you'll be in a rural area, but it's only for 3 years

This only works if your personal debt is really low. I never would have broken even with my paycheck every month with a 100K job as a doctor with student loan thrown in. Be sure you look at the bottom line when looking into these programs. I found I could make more with locums and pay my loans straight out.

 

[AlteredScale]

I totally get this. I graduated residency at 40, played with my kids for 4.5 years and at 45 started the year with the mantra of "debt free in 3". So I am one year in, my goal was to hit 300K this year (which I did), paid 250K in debt, have 400K to go. Now that includes my student loans, my condo, my house, my cars, and all other personal debt. I will be debt free in 2 more years if it kills me because I don't want to be doing a 70 hour week at age 50. I want to work part time and travel. It can be done in FP, you just have to know how to work it and make the money you want.

I think you should write an sticky thread regarding your success in this, I think it would be very helpful for us just starting med students!

 

[67552931811]

There are plenty of programs out there that gladly pay off your debts if you work for them. There are also IBR and PAYE. In short, you will pay it off in 10 years; 20 years at most if you choose IBR/PAYE. https://studentloans.gov/myDirectLoan/mobile/repayment/repaymentEstimator.action
There is some poster who made this awesome Excel worksheet that calculates how much you could pay off in a x year scenario: http://forums.studentdoctor.net/thr...tions-of-dental-school-excel-document.868931/

And what will you do when/if the government decides to cut those programs for physicians? Oops, now you're on hook for close to a mil in debt.

And, the 10 year plan is the PSLF not IBR/PAYE, which is in an even greater danger of being cut now that the Senate is Red. Look I do NOT disagree with you re: going for your passion. But, it is disingenuous to tell ppl to just go for their passion and to disregard the debt in question.

To be fair, there are some incentives in going FM due to loan forgiveness/repayment programs. Yea, you'll be in a rural area, but it's only for 3 years

For sure for sure. But, the catch may not be worth the pay off.

 

[Dave Chester]

This only works if your personal debt is really low. I never would have broken even with my paycheck every month with a 100K job as a doctor with student loan thrown in. Be sure you look at the bottom line when looking into these programs. I found I could make more with locums and pay my loans straight out.

100k? Nah. These programs pay you normal doctor salaries. And you don't have to worry about your student loans because they pay them off for you. See "National Health Service Corps|Public Heath Service" forum or Google for more details.

But, it is disingenuous to tell ppl to just go for their passion and to disregard the debt in question.

I did my calculations: Even if I work as a PCP for $200k while owing $320k in debt, I'll be able to pay it off in 10 years standard repayment plan and still have $100k+ left per year to live on.

 

[cabinbuilder]

I think you should write an sticky thread regarding your success in this, I think it would be very helpful for us just starting med students!

I don't know how to do this or what it means. Sorry, not that savvy

 

[AlteredScale]

I don't know how to do this or what it means. Sorry, not that savvy

No worries! I think it's just creating your own thread here regarding what you did in order to pay off your debt in three years. If enough users think it's very useful then SDN admin will "sticky" it so it stays at the top as a useful thread.